Part I: Why Pregnancy and Childbirth Must Be Voluntary and Planned — No Matter What

In all of the abortion and contraception “debates”, the rigors and hazards of pregnancy and childbirth and the ramifications of forcing women to go through that against our will gets conveniently ignored and brushed aside as if anything women are forced to suffer somehow doesn’t matter. This report shows the legal, ethical, medical and humanitarian claims that support a woman’s human right to bodily autonomy and bodily integrity, particularly with respect to reproductive health choices.

Anti-abortion/anti-contraception groups and well-heeled religious lobbies downplay the trauma, risks, side effects, pain, disfigurement and injuries that even “good” pregnancies impose on women. Fake crisis pregnancy centers don’t mention these risks or do referrals for women who cannot go through/do not want to go through an unplanned pregnancy. Mandatory ultrasound laws and waiting periods in several states place an undue burden on women seeking abortion and these laws also require doctors to lie to their pregnant patients about the risks and hazards of their pregnancies and giving birth, and the presence of any condition or fetal abnormality that threatens the health and life of the pregnant woman and/or her fetus.

Getting stuck in traffic is an inconvenience, being forced by public law and policy to go through pregnancy and childbirth against your will while having to suffer any or all of the inherent risks and side effects is not.

Normal or expectable side effects of pregnancy:

exhaustion

gestational diabetes – can remain permanent as Type II diabetes

altered appetite

nausea and vomiting

heartburn and indigestion

constipation

weight gain

hypothyroidism

dizziness and light-headedness

bloating, swelling, fluid retention

hemorrhoids

hematoma (usually on the vulva but can be on the inside of the vagina)

abdominal cramps

yeast infections

congested/bloody nose

acne and skin disorders

skin discoloration

mild to severe backache and strain

increased headaches

difficulty/discomfort with sleeping

increased urination/incontinence

gum disease (leading to premature tooth loss)

pica

breast pain and discharge

swelling of joints, leg cramps, joint pain

difficulty sitting/standing in later pregnancy

inability to take regular medications

shortness of breath

higher blood pressure

hair loss (this is a permanent side effect)

anemia

inability to participate in some sports and activities

high susceptibility to infection (pregnant women have a much lower immunity to illness, infection and disease than non-pregnant women or men because the pregnant woman’s immune system has to literally shut down so her system’s antibodies don’t attack the implanted fertilized ovum)

extreme pain during labor and delivery (which can last for several hours to several days)

hormonal mood changes, including post-partum depression

post-partum psychosis/birth related PTSD (caused by a birth that was traumatic for the woman)

extended post-partum recovery period and exhaustion (a difficult vaginal birth or a C-section can take a year or more to fully recover)

Normal, expectable, and frequent permanent side effects of pregnancy and birth:

stretch marks

loose skin

permanent weight gain or redistribution

permanent change to pelvic skeletal and ligament structure — it is not uncommon for a woman’s hips to be 4” wider than normal for the passage of the fetus during birth as her pelvic bone opens and ligaments stretch, and often this change is permanent, leaving many women unable to EVER get back into their pre-pregnancy clothes even if they lose ALL their pregnancy weight (leaving poor women, who are unable to afford to replace all their pre-pregnancy clothes, with absolutely nothing to wear except a couple pairs of oversized sweatpants and maybe one or two donated used maternity outfits)

other permanent aesthetic changes to the body (which can be devastating to a woman’s life chances for everything from finding a marriage partner to getting a good job in a culture that emphasizes women’s value on youth, thinness and beauty)

gestational diabetes — often remains permanent in the form of Adult Type II diabetes resulting in permanent debilitating health condition requiring medication, frequently leading to blindness and limb amputations (aggravated by lack of ability to afford healthy food low in starches and sugars)

placenta previa (causes laboring women to bleed to death during delivery)

thrombocytopenic purpura (causing women to bleed to death during/immediately after birth)

permanently ruined sex life from injury to the nerves and tissues of the sexual organs (caused by 3rd and 4th degree vaginal tears, episiotomies received by 85-90% of all birthing women, paraurethral tract and parasympathetic nerve trauma, etc. during delivery often accompanied by permanent fecal and/or urinary incontinence)

obstetric fistula – (tear/hole due to tissue damage from pressure to the area separating the vagina from the rectum or the vagina from the bladder; causing urine and/or feces to pass through the vagina uncontrollably. Fistulas require surgery and are not always able to be repaired 100% even after several subsequent surgeries)

colostomy – caused by an irreparable obstetric fistula and trauma to the internal pelvic organ system from pregnancy and giving birth

More permanent side effects:

poverty

future infertility

autoimmune disease

ovarian cancer

breast cancer

permanent disability

death

Since the passage of Roe v. Wade up until the recent Planned Parenthood clinic closings, 40 million women safely terminated unwanted pregnancies. During that same period, 21 million women died from pregnancy complications or during/shortly after giving birth. 400 million women have sustained debilitating permanent health problems, side effects, disabling childbirth injuries, and disfigurement which utterly destroyed their lives. A woman dies in childbirth every 90 seconds, according to WHO and Amnesty International. A trip to any old country cemetery will quickly verify the multitude of women’s premature deaths as casualties from men’s “right” to an orgasm at women’s expense. This is what male privilege costs women.

According to obstetric specialist and colorectal surgeon Dr. Michelle Thornton from the UK (which has a much better maternal health outcome than the US), about 40% of all women who have given birth sustain pelvic organ damage that Kegel exercises could not prevent or cure, leaving them with permanent fecal and urinary incontinence — undermining their confidence, ruining their sex lives and destroying their marriages/relationships, and decimating their ability to function at most jobs. Thornton states that the problem is underreported because women are too ashamed and embarrassed to tell their spouses and partners, let alone their doctors. Even when the surgical repair of fistulas caused by tears, episiotomies, and obstructed labor is successful, the physical limitations on women and compromised organ tissue’s integrity remains permanent; costing women everything from being able to participate fully in society to resuming a normal healthy sex life to re-entering the workforce or continuing their educations.

Maureen Treadwell of the Birth Trauma Association confirms this devastation and the unreported frequent occurrence of this “silent epidemic.” The trauma from the emotional and physical fallout left many women unable to contemplate another baby.

Many women’s bodies don’t handle pregnancy and childbirth well. Not all women will suffer the worst results and side effects but there is no way to accurately predict which women will and which ones won’t.

As to the claim that pregnancy and childbirth — particularly childbirth without adequate pain relief — is “natural to the female condition”; the natural course for appendicitis without unnatural man-made medical remedy is 30% chance of death from peritonitis. And if it’s “only natural” for all women to want to go through pregnancy and childbirth every year of their lives from puberty to menopause, then we don’t need any unnatural man-made laws to force women to go through it.

Human beings do not have a “reproductive drive”, we have a sex drive. The human sex drive extends far beyond childbearing years because the primary function for the human sex drive is the emotional pair-bonding even when childbearing is not desired or possible. The human sex drive is also the strongest natural force second only to the natural drive to defend one’s own life.

A marriage license will not prevent an unwanted and/or medically dangerous pregnancy and abstinence-only is a recipe for relationship failure in a nation with a 50% divorce rate.

Forced pregnancy and childbirth is no more moral than any other form of forced organ donation. No “pro-life” laws exist anywhere that force men to suffer trauma, pain, disfigurement and risk of death from mandatory kidney donation surgery to save the life of another — even if the person in need of it is his own child who would otherwise die without it. No one has the right to the use of, or to coerce the use of, another’s body — in whole or in part — against their will.

Consent to sex is not consent to pregnancy. Medical ethicist and philosophy professor David Boonin framed the argument supporting a woman’s right to choose based on consent. A woman has the right to refuse use of her body to support another potential human’s continued existence if:

The cost is not trivial (even “good” pregnancies in healthy women of optimal childbearing age are non-trivial).

The woman has not previously consented to the exact conditions of use, or the conditions which she consented to have changed.

The woman does not owe the recipient (fetus) compensation for causing its worsened condition.

Boonin quite specifically excludes a woman who conceived following consensual sex from obligation to provide life support for that developing entity. The fetus would not have existed without this act and its accompanying male act, and is therefore better off — not worse off. The female host has not caused any harm to the fetus at all and is therefore not required to compensate it by being an incubator. The fetus on the other hand, is harming its host, and is therefore obligated to her. And the male that has caused the woman harm by impregnating her when she didn’t want to become pregnant is therefore obligated to compensate her.

Any woman who wants to gestate some man’s genetic material for his benefit in almost a year of involuntary servitude is more than welcome to do so. But no woman owes such sacrifice and martyrdom to anyone — especially not to a society that has always treated women like garbage; a society that grants full personhood to 15 second old zygotes and corporations while denying that very same status of personhood to the woman in whose body that zygote is being hosted.

Forcing women to get and remain pregnant against their will is a violation of human rights, period.

The idea that fetal pain matters but the pain, trauma and disfigurement women are expected to suffer in childbirth as a mandatory punishment for having sex shows just how easily the UN Convention of Torture can be subverted when it’s women being targeted for sexual and reproductive torture.

Denying women the human right to have control over what happens to our bodies by imposing a sexual double standard in denying us access to reliable contraception and abortion, and denying women adequate pain relief during childbirth without a scientifically valid reason (and there really isn’t any) while making sure Viagra and penis stents are legal, available, and covered by most insurance plans for any man that wants to have “recreational” sex — is state-sponsored discrimination, gender-specific torture and a crime against humanity.

The legal language in Article 1 of the UN Convention Against Torture and Other Cruel, Inhumane, or Degrading Treatment or Punishment spells out the definition of torture. This was ratified by the US Senate in 1994. Torture is the intentional infliction of severe mental or physical pain or suffering by, or with the consent of, state authorities for a specific purpose. Methods of torture include rape, sexual assault, and forced childbirth.

No matter how “pro-lifers”, social conservatives, and Christians want to spin it, the devastating effects and injuries of torture cannot be justified by “moral beliefs” or “faith.” In 2006, the same US Conference of Catholic Bishops (USCCB) that is today in 2012 promoting the sexual and reproductive torture of forced pregnancy and childbirth against an entire identifiable group of people (women), asserted that policies permitting torture and inhumane treatment are “shocking and morally intolerable.” The USCCB also said, “Let America abolish torture now — without exceptions.”

Apparently, abolishing torture “without exceptions” doesn’t apply to women. This same powerful Vatican lobby group promotes the torture of women and girls with forced childbirth, even at peril to our health and lives, by influencing Congress and shaping public policy to deprive women of access to contraceptives and abortion — even in cases of rape or where pregnancy will kill a woman. That’s what “conscience clause” laws and “fetal personhood” laws being pushed by sadistic misogynists under the respectable habiliments of “moral beliefs” and “religious liberty”: Torture and chattel enslavement of women, no matter the harm and cost to us.

Part II: Medical Ethics and Religious Liberty

This is not a question of “freedom of religion”, it is about women’s human rights, legal and judicial equity, and medical ethics that are being violated by others’ abuse of the extra privileges that religious organizations enjoy and use like a loaded weapon to push harmful laws and public policy that target women for harm and injustice based solely on women’s vulnerability to pregnancy and sexual violence in a culture of impunity centered on male privilege.

When religious hospitals, Christian doctors, nurses, midwives and pharmacists serve the public, they serve people of different faiths. At this point, a sectarian institution or an individual of a particular faith relinquishes the right to coerce or force others into following a particular religious doctrine or teaching.

According to the IRS, in order to qualify as a 501(3)(c) non-profit religious organization, churches and their affiliated organizations must:

Not use a substantial part of their money or activities to attempt to influence legislation.

Maintain purposes and activities that are legal.

Not use their money and activities to intervene in political campaigns.

Not violate fundamental laws and public policy.

Patient abandonment resulting in patient harm or death is criminal. Deliberate patient abandonment resulting in patient death is murder. Murder is a crime. No institution or individual has the right to torture, abuse, or murder pregnant women in the name of “religious liberty.” Sacrificing the health, wellbeing, and lives of women as a class due to “conscience clause” laws arising from states’ expansion of the Church Amendment (passed in 1973 immediately after the US Supreme Court ruling in Roe v. Wade) enacted to protect “religious liberty” brings the entire American medical establishment, justice system, and system of government into disrepute.

Hemorrhage from ectopic pregnancies is the leading cause of maternal death in the first trimester of pregnancy. Management of ectopic pregnancy that saves the life of the mother includes the use of methotrexate (medical therapy), removal of the embryo (salpingostomy), removal of the section of fallopian tube (salpingectomy), and “expectant management” (waiting for the fallopian tube to burst and then using surgical intervention). Expectant management is the most painful and dangerous option and it is the only one that the “Directives” at Catholic hospitals permit, even though it has cost women their lives or left them permanently disabled.

The Ethical and Religious Directives for Catholic Hospitals and Catholic-affiliated Healthcare Service Centers (the “Directives”) issued by the US Conference of Catholic Bishops (USCCB) prohibit abortion and prohibit health care providers from taking “direct action” against the embryo, even though ectopic pregnancies are not viable.

Patients with ectopic pregnancies, incomplete/inevitable miscarriages at Catholic hospital emergency rooms have been transferred to non-Catholic hospitals without treatment or stabilization. In some cases, patients could not be stabilized for transport to another facility.

Directive 47 allows for abortion to preserve the woman’s health or life, stating “Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”

But the interpretation of what constitutes a “serious pathological condition” has been left up to local bishops and Catholic medical ethics directors to decide — most whom have never gone through pregnancy and childbirth.

In November 2009, a 27 year old mother of 4 was admitted to St. Joseph’s Hospital in Phoenix, Arizona. She was 11 weeks pregnant. According to a hospital document, she had “right heart failure” from pregnancy-related pulmonary hypertension and continuing the pregnancy meant nearly 100% chance of maternal death. The patient was unable to be stabilized enough to be moved into the operating room, never mind stabilized enough to be transported to a non-Catholic hospital 90 miles away. Relying on Directive 47, Sister Margaret McBride on the ethics committee authorized the life-saving abortion. The mother survived. The nun who saved her life was fired from her job and excommunicated by Bishop Thomas Olmstead.[1]

Father John Ehrich, the medical ethics director for the Diocese of Phoenix, said, “There are some situations where the mother may in fact die along with her child. But — and this is the Catholic perspective — you can’t do evil to bring about good. The end does not justify the means.”

Father Ehrich also stated that “pregnant women should embrace death rather than having to live the rest of her existence knowing that she had an abortion.”

With medical ethics directors like Father John Ehrich sitting in positions of tremendous power, privilege and authority overseeing doctors and hospitals across the US, this country is not safe for women.

Bishop Thomas Olmstead affirmed the church position for letting women die from treatable pregnancy complications despite Directive 47 and wrote a letter to the USCCB defending that position, stating, “Abortion is always immoral, no matter the circumstances, and it cannot be permitted in any Catholic institution.”

The IBIS Reproductive Health Study in 2009[2] conducted for the National Women’s Law Center interviewed more than 1,500 physicians, administrators, and clinicians from 69 Catholic hospitals across the US. Some respondents spoke at length about the influence of state legislation on hospital practices and policies, particularly in the realm of emergency contraception, sterilization, and medical abortion. Doctors told of seeing women bleed to death from incomplete miscarriages[3] and seeing patients suffer in agony from fallopian tube rupture because of delays in treatment.

Several physicians expressed concerns of losing their hospital practicing privileges and their jobs if they violated the Directives even though doing so was in the patient’s best interests, even in life and death matters for the patients. Several physicians were reprimanded or demoted for violating the Directives by performing tubal ligations in cases where the patient requested it and where additional pregnancies would likely be fatal for them.

Lori Freedman, PhD at the Bixby Center for Global Reproductive Health and Debra Stulberg, MD at the Department of Family Medicine at the University of Chicago conducted extensive research[4] on the effects on women when they’re denied bodily autonomy in reproductive health matters, specifically with respect to voluntary and/or medically advised sterilization when “moral beliefs” and “freedom of religion” is allowed to trump women’s basic human rights to life, bodily autonomy and bodily integrity.

Freedman’s and Stulberg’s research shows that the primary disadvantage for doctors working at Catholic hospitals (and the women they treat) was the inability to perform sterilizations, particularly following a C-section (eliminating the need and trauma of a second, separate surgery). This was supported by fact-finding research by the Center of Reproductive Rights and the IBIS Study in communities where previously secular hospitals came under Catholic control through mergers and acquisitions.

One doctor described the impact of the denial of sterilization to women per adherence to the Catholic doctrine[5]:

“There are only so many C-sections a woman should have. With each one the next pregnancy is markedly compromised. There is a higher risk the placenta can implant on the uterine scar. You can’t get the placenta out, there’s morbid hemorrhage. It’s absolutely unconscionable. The pope, the cardinal, the board is not going to be there, not going to be here when she is hemorrhaging, bloody, you can’t see, it’s horrible, the uterus is cut, and she needs a massive transfusion. Six months later she still looks awful, like death warmed over; she can’t take care of the little ones she has.”

For women with difficulty accessing reliable long-term contraception, sometimes sterilization is the only viable option. Denying women that option has been fatal. All of the doctors interviewed in this exhaustive research endeavor told stories of women under their care who had been unable to obtain reliable birth control and sterilizations who had subsequently gotten pregnant when they did not want to and were medically advised not to, and one woman who requested a tubal ligation but couldn’t get it had 6 children and had ended up dying in childbirth as the result of an unwanted additional pregnancy.

For many women, a post-partum sterilization is recommended when additional pregnancies are not only undesired but would also threaten the woman’s health. Refusing to perform a requested sterilization, especially immediately following a childbirth, means denying women patients wanted and needed medical care that can even mean denying women their right to life. It also imposes the undue burden of additional costs in terms of money and physical recuperation time for a second, separate surgery.

For women for whom immediate post-partum sterilization is desired and/or medically advised, refusal to allow this procedure to be performed based on “moral beliefs” of practitioners and religious directives to which hospitals subscribe amounts to unethical and immoral denial of care.

Standards of care are defined as the practices that are medically necessary and the services that any practitioner under any circumstances should be expected to render. The ACOG has recognized that a patient’s health should always come first, and that access to health services should be based on the patient’s medical needs, not the provider’s personal or religious beliefs. In a recent Committee on Ethics Opinion[6], the ACOG states that the patient’s autonomy, and physical and mental health, limits the physician’s ability to refuse. The ACOG recommends that a provider’s personal beliefs can be accommodated only when the primary duty to the patient can be fulfilled.

But the American Medical Association (AMA) caved in to the pressures exerted by the all-male Catholic Church hierarchy, even though it too has previously addressed conscientious refusals in the context of hospital mergers. Despite the AMA core principle of medical ethics that states “a physician, while caring for a patient, must regard responsibility to the patient as paramount”, the AMA allowed for a watered-down resolution that reaffirmed the importance of access to reproductive health care but also stated that “medical professionals and hospitals should not be required to violate personally held moral principles.”

Denials of care by refusal of medical goods and services based on religious and “moral” objections have expanded to include the right not to provide care, not to provide referrals, and not to offer information (even if the patient requests it) about a range of legally available care and legally approved pharmaceuticals. Decisions to deny information and medical services based on “moral” and religious beliefs rather than scientific and medical evidence has resulted in poor health outcomes for women. Nearly every “moral objection” invoked under the cover of religious liberty exclusively targets women for the reproductive health conditions solely experienced by women.[7]

The American College of Obstetrics and Gynecology (ACOG) in attempting to “balance the interests” and acknowledge the legitimate place for individual medical practitioner conscience in medicine also warns that “conscience may conflict with professional and ethical standards and result in inefficiency, adverse outcomes, violation of patients’ rights, and erosion of trust if one’s conscience limits the information and care provided to a patient.”

The ACOG notes that “conscience clause” related refusals of medical procedures and pharmaceuticals almost always without exception occurs in the realm of women’s reproductive health. The ACOG states: “It is not uncommon for conscientious refusals to result in imposition of religious or moral beliefs on a patient who may not share those beliefs, which may undermine respect for patient autonomy. Women’s informed requests for contraception or sterilization are an important expression of autonomous choice regarding reproductive decision-making. Refusals to dispense contraception may constitute a failure to respect women’s capacity to decide for themselves whether and under what circumstances to become pregnant.”

Addressing tubal ligation specifically, the ACOG Ethics Committee Opinion states: “Although conscientious refusals stem in part from the commitment to ‘first do no harm’, their results can be just the opposite…religiously based refusals to perform tubal ligations at the time of Cesarean delivery can place a woman in harm’s way — either by putting her at risk for an undesired pr unsafe pregnancy or by necessitating an additional, separate sterilization procedure with all its attendant and additional risks.”

The American tradition is one of preserving a neutral position towards religion in order to allow believers of many faiths including non-believers in any faith, to work and live alongside one another peaceably under one common government. This requires respect for one another’s human rights, mutual tolerance, and practical accommodations. No purity for any specific religion and its members can be expected under this arrangement because the US is not a theocracy nor does is the government allowed to favor one religion and its members over everyone else.

Religious organizations cannot discriminate against employees of a different race or gender, or dictate how employees spend their paychecks. They cannot discriminate when hiring for non-clergy positions, even within a church. And they cannot use their religious or “moral” beliefs as grounds to deny another person, or class of persons, human rights to bodily autonomy and bodily integrity.

But social and religious conservatives and the Vatican’s political lobby group, the USCCB, have violated this arrangement. They have hijacked every aspect of our common government from Congress to state legislatures to the Supreme Court to government agencies that make public policies behind closed doors. And they have declared a War on Women with acts of legislative and judicial aggression that translate to real physical aggression and harm specifically against women and girls.

The issue is not whether religious liberty should be further protected — but whose religious liberty deserves the protection of the law, and at what cost in terms of real tangible harm to whom.

Congress, state lawmakers, and judges are ruling on case law, passing amendments and enacting legislation that create a far-reaching power — on “moral” or religious grounds — to trespass on the inalienable human rights and religious liberty of individuals. This violates the spirit of the establishment clause of the First Amendment. And it allows petty tyranny to trump bodily autonomy and bodily integrity, and gender discrimination to prevail over equity and fairness.

The Institute of Medicine, the ACOG, and women who are vulnerable to pregnancy and all its inherent risks and side effects are more qualified to decide the merits of contraception, abortion, and voluntary sterilization than clergymen and a group of historically privileged people (men) that will never suffer the consequences of unwanted and/or medically dangerous pregnancy, pregnancy complications, maternal disability, or maternal death.

The ACOG Ethics Committee proposed the following recommendations for medical professionals’ consciences without compromising the health and wellbeing of the women they serve:

In the provision of reproductive services, the patient’s wellbeing must be paramount. Any conscientious refusal that conflicts with a patient’s wellbeing should be accommodated only if the primary duty to the patient can be fulfilled.

Health care providers must impart accurate and unbiased information so that patients can make informed decisions about their health care. They must disclose scientifically accurate and professionally accepted characterizations of reproductive health services.

Where conscience implores physicians to deviate from standard practices, including abortion, sterilization, and provision of contraceptives, they must provide potential patients with accurate and prior notice of their personal moral commitments. In the process of providing prior notice, physicians should not use their professional authority to argue or advocate these positions.

Physicians and other health care professionals have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that their patients request or need.

In an emergency in which referral is not possible or might negatively affect a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care regardless of the provider’s personal moral objections.

In resource-poor areas, access to safe and legal reproductive services should be maintained. Conscientious refusals that undermine access should raise significant caution. Providers with moral or religious objections should either practice in proximity to individuals [other providers] who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide. Rights to withdraw from caring for an individual should not be a pretext for interfering with patients’ rights to health care services.

Lawmakers should advance policies that balance protection of providers’ consciences with the critical goal of ensuring timely, effective, evidence-based, and safe access to all women seeking reproductive services.

But this “balance” framed within the ACOG Committee’s recommendations is not what’s happening. When University of California student Heather Minton was raped in Riverside on a Friday evening in November 2003 and had a friend take her to the emergency room of the local hospital, Minton was denied emergency contraception at the Riverside Community Hospital. The ER nurse told Minton’s friend that if Minton hadn’t been raped she wouldn’t treat her, and suggested they try another hospital ER a half-hour’s drive away[8]. Emergency contraception is time-sensitive: it must be taken within 72 hours of the unprotected sex act to prevent pregnancy.

Minton said, “When we got to the emergency room, I was hysterical. No one knew what had happened to me, just that I had had sex and I wanted EC. But the nurse sent us to another hospital. It was after 2 AM, and we didn’t know where we were going or whether they’d refuse to treat me too.”

State laws have been giving hospitals, doctors, nurses, SANE’s, and pharmacists the right to refuse to offer emergency contraception or even prescribe birth control, fill birth control prescriptions, or provide IUD’s, shots, implants, low-hormone vaginal rings, diaphragms and cervical caps — all of which require an exam and fitting or insertion from a medical professional — since the 1990’s when states began aggressively expanding the Church Amendment (passed on the heels of Eisenstadt v. Baird in 1972 and Roe v. Wade in 1973 in the name of “religious liberty.”).

Since the 2010 mid-term Congressional elections, 1,100 more laws were proposed — and many were passed — that has made safe legal abortion and contraception access nearly insurmountable for millions of American women.

Because these conscientious refusal policies are rarely publicized, and often it is a discretionary matter left to the individual medical professional or pharmacist, it is unbelievably difficult for women seeking emergency contraception to know who they can trust will help them and who won’t. Delays can render time-sensitive emergency contraception, birth control refills, including replacement IUD’s, ineffective. The result is that women and girls are being forced to become pregnant against their will, at peril to their health and lives, traumatizing them, stripping them of their human dignity, and effectively violating rape victims after the rapist violated them initially.

Riverside Community Hospital declined to comment. Spokesmen for HCA, the corporation that owns the hospital, said that HCA does not dictate clinical policy to its facilities and physicians can use their own discretion. Anonymous calls to Riverside on three different occasions to different nurses on duty produced three different responses: “We do not offer emergency contraception”, “It depends on the physicians on duty because emergency contraception is an ethical issue”, and “We offer emergency contraceptives to women who have been raped.”

Even after the emergency contraceptive, Plan B, was made available for over-the-counter purchase, women must still run through a gamut of hurdles to get it. Plan B is kept behind the pharmacists’ counter rather than in the aisles. Women must still ask the pharmacist or pharmacy clerks for it, and they still have the right to refuse to sell Plan B in an arbitrary and capricious manner even though no prescription is required for women over the age of 17. Pharmacists and their assistants have lied to women requesting Plan B, saying that it is not in stock or that the pharmacy does not carry it, even when it is in stock. Recently, a study showed that many pharmacists deliberately deny Plan B to teens when they present a prescription from their doctor.

Yet, men seeking to get prescriptions for Viagra filled or seeking to buy condoms have no difficulty getting what they need to ensure that they’re able to have “recreational” sex — whether in committed relationships, extra-marital affairs, one-night-stands, with or without a woman’s consent. While pregnancy and childbirth pose serious risks to women’s health and lives and change their bodies in irrevocable ways, no man has ever been maimed or died from the inability to get an erection.

Directive 36, handed down by the Vatican, states that in the case of sexual assault, a woman may receive emergency contraception from a Catholic provider. But many Catholic facilities refuse to provide it anyway while others require a full medical exam and pregnancy test, delaying access to Plan B beyond the time it would be effective.

Teresa Harrison, project manager at IBIS Reproductive Health, a non-profit research organization, says, “There is no enforcement of laws requiring hospitals to provide emergency contraception in cases of rape. Without enforcement, there are no incentives for hospitals to abide by the law.”

Although the medical establishment and science defines “pregnancy” as implantation of a fertilized egg, religious extremists define it at conception; the second the sperm meets the egg. Arizona lawmakers now are trying to define it as two weeks prior to conception — a belief held by Father Frank Pavone of Priests for Life and PersonhoodUSA.

In August 2002 the “Emergency Contraception in Catholic Hospital Emergency Rooms” study conducted by Catholics for a Free Choice, only 167 of the then-597 US-based Catholic hospitals offered emergency contraception to rape victims. This same study also reports that Catholic hospitals provide health care to 1 in 5 people across the US.

According to the American Journal of Preventive Medicine, approximately 25,000 women in the US get pregnant each year from rape. The actual toll may be higher, since 54% of all sexual assaults go unreported to the police, 97% of all rapists never spend a day in jail, and 38% of all rapists were a friend or acquaintance of the victim.[9]

Harrison says that most Catholic hospitals align with the views of their local bishop. Access to emergency contraception for rape victims, tubal ligations following C-section or after a difficult childbirth, and even life-saving abortions where a pregnant woman is “bleeding out” or women with a high risk of dying from other pregnancy complications (eclampsia, placenta previa, placental abruption, cardiomyopathy, pulmonary hypertension, etc.) — women will be denied care and die, not because there’s a lack in medical technology and medicines, but solely for being female and pregnant depending on the views of a bishop and the “moral beliefs” of the ER physician, SANE’s, and nurses.

Although scientists, doctors, the ACOG, the AMA, and state health departments tried to clarify differences between Mifepristone (RU-486, the abortion pill) and Plan B, anti-woman Christian groups like Americans United for Life, Personhood USA, and Priests for Life continue to spread false information and lies that Plan B “kills babies.”

None of them care, however, that pregnancy and childbirth is very physically and emotionally traumatic even under the best of circumstances and wreaks havoc on women’s bodies and psyches and can sometimes even kill perfectly healthy women — women’s lives don’t matter. Dr. Gene Rudd, associate executive director of the Christian Medical Association, wrote in the Annals of Pharmacotherapy that “scientific evidence indicates that the drug works in part by preventing a developing embryo from attaching to the uterine wall, leaving it to pass out of the mother’s body and die.”

In 2004 in Denton, Texas, Eckerd pharmacist Gene Herr and two colleagues refused to fill a prescription for Plan B for a traumatized rape victim, and demoralized her. Herr is a “hero” in anti-woman circles.

In Faben, Texas a few weeks after the Denton incident involving Gene Herr, the small town’s only pharmacist and a self-described “Christ follower” Steve Mosher refused to fill the birth control prescription of a married woman who had just recently given birth a few weeks prior. The woman and her husband had to drive 40 miles roundtrip to El Paso to get her prescription filled.[10]

In July 2006, an 18 year old rape victim in Lebanon County, Pennsylvania was denied Plan B by the ER doctor on duty at Good Samaritan Hospital. He refused to write her a prescription because of his “religious beliefs.” The victim was forced to “beat the clock” in getting a prescription from her gynecologist only to then find that the one and only pharmacy in her area that carried Plan B was all out.

Through physical force and violence (including the use of drugging victims against their knowledge), rapists deprive women of the right to have control over their own bodies. Since emergency contraception is only effective if taken within 72 hours of unprotected sex, Plan B is time-sensitive and that requires that women have immediate access to it. Women have a basic human right to reclaim control over their bodies after a traumatic rape by having the ability to choose whether or not they get pregnant and suffer more trauma, pain and risk dying as a result of that rape.

Although Plan B was eventually approved by the FDA for over-the-counter sale, women (especially young women) are still denied access, thus women’s human rights have been subordinated to rapists’ sperm under the guise of “religious liberty.”

According to the Duvall Project[11], only 47% of Pennsylvania hospital emergency rooms offer information about or directly provide emergency contraception to rape victims as part of a basic standard of care. The CARE Act — Senate Bill 990 and House Bill 2159 — is critical Pennsylvania state legislation that would protect the human rights of rape victims by ensuring that rape victims get comprehensive medical care, including emergency contraception, when they present at emergency rooms.

But “religious liberty” was once again used to rob women of their human rights by state lawmakers whose amendments to the CARE Act added a religious facilities exception creating two classes of rape victims: One group would get comprehensive care including access to emergency contraception while the other group of rape victims would be denied that care because they were unlucky enough to be taken by ambulance to a Catholic hospital or living in a region where the only hospital was a religiously affiliated facility that does not believe that women deserve comprehensive care, giving extra reproductive rights to rapists at the expense of their victims.[12]

No woman should be forced to suffer additional emotional and physical trauma of an unwanted and medically risky pregnancy after a rape and given inferior medical treatment because of medical facilities’ or individual practitioners’ religious beliefs. Sexual assault is dehumanizing. For survivors to regain their sense of self-worth and control over their bodies, which serves the common good for all in society, comprehensive care should not take a back seat to someone else’s religion or “moral beliefs.”

Ensuring that rape victims are able to get emergency contraception helps survivors regain a sense of control over their own bodies and lives following sexual assault. The FDA approval for over-the-counter sales of Plan B has only removed a small portion of the barriers for women who have been raped. Women under 17 still need a prescription.

In rural areas like Erie County where the nearest Planned Parenthood is two hours’ drive away in Ohio which does not accept Pennsylvania (or any other state’s) Medicaid, women still have difficulty getting to a pharmacy that will sell it since this item is still kept behind pharmacy counters where the on-duty pharmacy staff takes control away from women by capriciously refusing to sell it to them — with or without a prescription. The price of emergency contraceptives ranges from $50 to $250 for a single dose. This leaves poor women without resources and a car in rural regions like Erie County, Pennsylvania without adequate remedy at law.

Although the City of Erie has a family planning clinic, Adagio Health, which provides some limited birth control options, Adagio will not provide emergency contraception or referrals for emergency contraception or abortion, no matter what the woman’s circumstance is.

This allows strangers to use their conscientious refusal rights to legally act as collaborators and accomplices with rapists in the commission of sexual/reproductive violence against women and girls — turning poor rural parts of the state into de facto government-approved open-air rape gulags. This scenario is common across the US.

The basic human rights to bodily autonomy and bodily integrity should never be framed as a social class privilege that only some people deserve based on socio-economic status, gender, race, or geography at the whim of strangers whose bodies and lives are not 100% at risk in unwanted and/or medically dangerous pregnancies — especially as a result of rape. Meanwhile, several Congressmen have pushed laws forward that redefine “rape” to further disenfranchise rape victims.

What other subgroup of the population is it acceptable to strip of their dignity and basic human rights in the name of “religious liberty” or “states’ rights?”

A more recent study in 2011 conducted by Dr. Tracey Wilkinson[13], a general pediatrics fellow at Boston Medical Center/Boston University School of Medicine revealed that although it’s legal for 17 year olds to get emergency contraception (and those younger with prescriptions), pharmacy employees are misinforming teens by telling them they’re not allowed to get it, or saying that they don’t carry it even when it is in stock behind pharmacy counters. Wilkinson’s study showed that 1 in 5 young women are denied emergency contraception on the whim of pharmacy staff.

For this study, researchers posing as 17 year old girls and doctors seeking help for 17 year old patients called every pharmacy in five US cities asking about the availability and accessibility of emergency contraception. All callers asked questions from a script. The results showed that 19% of the 17 year olds were told that they couldn’t get it under any circumstances while only 3% of the doctors were told the same thing. Pharmacy staff gave the wrong information 43% of the time.

Wilkinson’s study shows there seems to be a deliberate attempt to force teen girls into unwanted pregnancies because of “moral beliefs” about teen girls and sex, regardless if the sex is consensual of not. Despite this, US Department of Health & Human Services Secretary Kathleen Sebelius invoked her authority to overrule the FDA’s recommendation to make emergency contraception available without a prescription to young women under age 17 even though most maternal deaths from complications during pregnancy or childbirth occur at both ends of the maternal age spectrum: girls under 20 and women over 35.

According to the Alan Guttmacher Institute, approximately 750,000 girls between the ages of 15 and 19 become pregnant every year and 85% of those pregnancies are unintended. The September-October 2007 issue of Ambulatory Pediatrics published a study by Dr. Elizabeth Miller and her research colleagues which showed that 26% of the teen girls studied responded that their partners actively tried to get them pregnant against their will by manipulating condom use, sabotaging the girls’ contraceptive use, and lying (“I’m sterile”), or making explicit statements about wanting to make the girls pregnant. Dr. Miller recalled one girl who came to her clinic for a pregnancy test and emergency contraception after the test showed negative for pregnancy — the girl was thrown down a flight of stairs by her boyfriend two weeks later. The micro mirrors the macro.

Nearly every sex education program fails to address the problem of forced pregnancy by abusive males who are using their penises like a loaded weapon to abuse, dominate, and utterly destroy women in our culture of impunity.

Dr. Elizabeth Miller’s newest study published in the January 2010 issue of the journal Contraception showed that 74% of women aged 18-49 reported having experienced some form of reproductive abuse, including forced unprotected intercourse, refusal to withdraw as promised, the sabotaging of condoms, flushing birth control pills down the toilet, and removing contraceptive patches and rings. Women who did become pregnant as a result were coerced or forced into going along with their partners’ wishes, who in some cases threatened to kill them if they got an abortion. These figures are consistent from clinic to clinic.[14]

Not one law has been passed to criminally prosecute men who cause injury, disability or death to women through the reproductive abuse of forced pregnancy and birth.

The US has a higher maternal death rate than 40 other countries. The Center for Disease Control (CDC) reports that two-thirds of maternal deaths in the US go unreported or are misclassified. Only 24 states have mandatory reporting laws for adverse pregnancy/childbirth/post-partum events. For each death, there are about 50 instances of complications related to pregnancy or childbirth that are life-threatening or cause permanent damage; and the “near misses”— including kidney failure, respiratory distress syndrome, shock, and the need for blood transfusions and ventilation — rose 25% from the late 1990’s to 2005. [15]

The percentage of unreported or misclassified maternal deaths was particularly high for women at the extremes of maternal age distribution. Half of all maternal deaths among teenagers and more than half of all maternal deaths among women over age 35 were misclassified or unreported. The US currently has no uniform method for reporting maternal deaths, something which certified midwife Ina May Gaskin brought attention to. The leading causes of maternal death — which is defined as all deaths causally related to pregnancy and childbirth — are hemorrhage, pulmonary hypertension, amniotic embolism, air embolism, and pregnancy/childbirth related cardiovascular disorder.

A pregnant woman or a woman who has recently given birth is more likely to die as the result of a cardiovascular disorder than any other cause. 6 out of 10 maternal deaths among 14-19 year olds were caused by cardiovascular disorder.

The lack of complete reporting of maternal deaths has led to misconceptions regarding the magnitude of the problem of maternal mortality. The findings of the underreporting of maternal deaths report compiled by Isabelle Horon with the Vital Statistics Administration of Maryland also reveal that a larger portion of maternal deaths from pregnancy complications in women who had not yet delivered were unreported, and deaths among this subgroup of pregnant women represented 19.3% of all maternal deaths for which the time of death was known.[16]

In March 2010, Amnesty International released its own report, “Deadly Delivery”, on the increasing maternal death rate in the US, which is double those in Canada, Britain and Western Europe — all countries in which women have wide access to birth control and safe, legal medical abortion These are all countries whose abortion rates are far lower than those in the US.

There is no question that an increasing lack of access to contraceptives, abortion, and voluntary sterilization due to the tremendous political and financial clout used by religious lobbies like the USCCB and the increased power over public policy have not only contributed to high maternal mortality and morbidity rates and the skewing of these statistics (which are used to justify legislation and shape public policy), but have also acted in synergy with deeply institutionalized misogyny to deprive women of human rights — in the name of “religious liberty” and “moral beliefs” — while actively promoting a de facto state establishment of religious policies that impact the public in violation of the spirit of the US Constitution.

Regarding maternal death and extreme misery and suffering that could be easily avoided through better access to contraception, sterilization, and abortion, Father Frank Pavone, national director of Priests for Life, responded by saying, “Only God has absolute dominion over human life.” He cites scripture to support mother-killing and the deprivation of women’s human rights: “None of us lives as his own master and done of us dies as his own master.” (Romans 14:7)

On his website, Pavone states: “This is also the reason contraception is wrong. God’s dominion over human life does not begin at conception. It begins in eternity” and he cites the same Biblical verse that undergirds the Christian patriarchy movement known as Quiverfull: “Happy the man who has filled his quiver with arrows!” (Psalm 127:5)

Lisa Metzger of the Quiverfull movement says, regarding her thoughts on the high risk of maternal death and morbidity within the Christian patriarchy community, that she is “obeying by giving God the keys to my womb…It’s his domain to create life!”

Regarding abortion, contraception, or sterilization to preserve a woman’s health or save her life, even if that life-threatening pregnancy was the result of a rape and even if her death will leave orphaned children, Metzger cites scripture to justify compulsory maternity at all costs: “No man can redeem the life of another or give to God a ransom for him…” (Psalm 49:7) and “Who of you by worrying can add a single hour to your life? Since you cannot do this little thing, why worry about the rest? O you of little faith!” (Luke 12:25, Jesus speaking)

The proliferation of “pro-lifers” and Christians into the medical field, particularly in obstetrics and gynecology, is leaving more women than ever before unable to obtain birth control to defend their bodies from medically dangerous and/or unwanted pregnancies. Women need to ensure their doctor’s or pharmacist’s religious or “moral” beliefs won’t cost them their lives or deprive them of full reproductive health care. Googling some examples of anti-contraception/anti-abortion physicians turned up some interesting results regarding doctors who read a book by Randy Alcorn:

“Scientific papers suggest that escape ovulation occurs 4-15% of all cycles in patients taking birth control pills. Thus, as this book points out, early chemical abortions are a real concern.” ~ Paddy Jim Baggot, MD, OB/GYN, Fellow of the American College of Medical Genetics

“In this challenging book Randy Alcorn has the honesty to face a tough and uncomfortable question. The compelling evidence will make you rethink the question of birth control.” ~ John Brose, MD, Surgeon

Women need to thoroughly investigate where their doctors, midwives, and pharmacists stand before investing any money and trust into a doctor-patient relationship. And this is all the more compelling of a reason why Title X funding should be increased, NOT decreased, for Planned Parenthood — women know that at least there they can get their reproductive health needs met without ugly surprises that could cost them their lives because of a medical professional’s “moral” beliefs.

Doctors, physician assistants, pharmacists, nurse practitioners, SANE’s, and midwives, et al, are products of the same deeply misogynistic society that produced Rush Limbaugh and Rick Santorum. Misogyny runs rampant in the medical community as it does throughout the rest of the social fabric. Abuse of gravid women during labor in delivery rooms by medical professionals is not uncommon.[17] Women have come forward and sued for physical and psychological abuse during childbirth. That abuse includes intimidation, coercion of unnecessary medical procedures, verbal abuse, and denial of adequate pain relief during labor, even during episiotomy repair.[18]

Across the US childbearing women continue to be abused physically and psychologically on a level that would constitute sexual assault and torture under any other context. Women are frequently punished by those in whose hands their health and lives are entrusted for failing to be sufficiently submissive to those in power over them in the top-down authoritarian structure of Western medicine.

Cruelty and abuse against women is reaffirmed and legitimized by the prominence of religious influence in government policy and public affairs. No other group of people is allowed to be tortured, abused, maimed, oppressed, or enslaved in the name of “religious liberty.” Until women are codified into the Constitution as full “persons” and “citizens” that are just as deserving of respect and equal protection of the law as men, and until women are viewed as being human enough for harm against us to matter, it is not safe to be a woman in the US.

Regardless of what faith one professes, a woman’s uterus is not designed to handle unmitigated, endless cycles of pregnancy and childbirth. A 2006 study pointed out that women who bear children at intervals of 18 months or less have a shorter lifespan and more health problems overall.

According to Stephanie Coontz, director of Research and Public Education at the Council on Contemporary Families, anti-contraception groups like Quiverfull and their Catholic counterparts have influenced government policy and laws under the guise of moral beliefs “to the extent that people get in positions of authority and planning — for instance, in the Department of Health & Human Services where they have control over abstinence-only education funds. Then you have choices being made behind closed doors about the options that will be available for everyone.”

R. Albert Mohler, Jr., president of the Southern Baptist Theological Seminary is considered one of the leading intellectuals of evangelical Christianity in the US. In a December 2005 column in The Christian Post titled, “Can Christians Use Birth Control?” Mohler wrote:

“The effective separation of sex from procreation may be one of the most defining marks of our age — and one of the most ominous. This awareness is spreading among American evangelicals, and it threatens to set loose a firestorm…A growing number of evangelicals are rethinking the issue of birth control — and forcing the hard questions posed by reproductive technologies.”

The intellectual force behind the assault on contraceptives and comprehensive sex education is Robert Rector of the Heritage Foundation who worked with Mohler to push a religious agenda centered on taking away women’s rights to self-determination. Rector wrote some of the federal legislation mandating abstinence-only sex education which has not reduced the rates of teen pregnancy. Mohler and Rector admitted to having an agenda of social engineering to force a change in behavior and in the way people think about sex — using the bodies of women and girls as human shields in their ideological war against the life, liberty, justice, and freedom of women.

Cheryl Seelhof and Vyckie Garrison who both left the Quiverfull/Christian patriarchy movement have told how this misogynist ideology masquerading as a religious belief deserving of extra protection played a role in the unreporting/misclassification of maternal mortality and morbidity rates and how the impact of Quiverfull ideology permeates public policy to the detriment of women’s lives. Seelhof said, “My whole family is conservative Christian…my mom and dad are Bush Republicans and subscribe to Rush Limbaugh’s publication.”

One woman who had six children and left Quiverfull told about the Christian patriarchy/Quiverfull communities’ standard practice of concealing maternal deaths from health and government agencies. She was a small Christian news journal publisher. She was told by others in the community not to publish any stories that would reveal the high maternal death rates. “The woman had been told from childhood she could not have children because of her heart problems. She got married and “left it to the Lord” and got pregnant and she and her husband decided to “trust God.” She died in childbirth at home…my columnist asked me not to tell anybody — the husband, the family, all in Bill Gothard’s program — didn’t want anyone to know. Which is typical of these folks. Don’t talk about the women who die in childbirth. Or the ones who attempt VBAC’s against all odds. Don’t get me wrong, I am totally supportive of VBAC’s for most women who have had C-sections, but sometimes it isn’t a good thing…one woman I know, her uterus ruptured along the old C-section scar and she nearly died, had to have blood transfusions, and then had to return home to her large family with a newborn. They don’t talk about the abuse…Many women left this movement and continue to leave, although at great cost. I have worked with women who have had emotional breakdowns and have been institutionalized, who have had to try to make it on their own with no employment background, no references (all their references turned against them when they left), 6-12 children to take care of and exes who refused to pay child support and were protected in that by church men.”

Without the right to control whether or not she gets pregnant or carries an unwanted pregnancy to term, a woman faces a potential life-threatening or health-compromising pregnancy every year from menarche to menopause — for 30 to 40 years of her life, unless a high risk pregnancy or sudden childbirth complication kills her before middle-age like unmitigated childbearing did to 1 in 5 women as recently as 1950; 22 years before the US Supreme Court ruling on Eisenstadt v. Baird (1972) which gave unmarried women the right to birth control access regardless of marital status.

To deny women the right to prevent or terminate an unwanted or medically risky pregnancy is to consequently deny her all basic human rights. It’s not a separate issue. It’s not a “special interest” issue. It’s not a frivolous issue. Not if one is a woman. It affects everything in her life. The right to determine what happens to your own body, the fundamental human rights of bodily autonomy and bodily integrity, are the sine qua non of ALL rights — including the right to “freedom of religion.”

If women’s human rights can be discarded, ignored, or postponed, then lawmakers are once again placing issues that directly and specifically relate to men at the top. There is no democracy or fairness in any sense of the word if double standards drive the issues. Democracy, freedom, and justice for only half the population but not the other is real no freedom or justice at all.

Throughout history, women have always been involved in the fight for labor (primarily benefiting white males), for the abolition of slavery, for the end of Jim Crow, for Civil Rights, and for LGBT rights. But as a class, women are still without equal rights as persons and citizens, or even basic human rights to our own bodies and lives. That is what is so patently wrong.

Don’t think that writing laws on any issue that brushes women aside by making men the default “normal” and therefore making women invisible, is something that can be “fixed” to include or benefit women later. That rarely, if ever, happens.

The Equal Rights Amendment (ERA) was defeated in 1980. Women still do not have explicit citizen rights and personhood status protection, or even basic human rights in this country. What does it say about women’s status in this country if less than half the states supported an amendment for equal rights that many men claim women already have? Why not just pass the ERA? Unless the reason perhaps is that most men really don’t want women to have basic human rights.

If women have no rights to self-determination and bodily autonomy, then the economy, jobs, education, infrastructure, defense, religious liberty, and all the rest no longer matters.

[5] Freedman and Stulberg interview with Dr. Gwen Patterson, OB/GYN at Sierra Vista Regional Health Center in Sierra Vista, Arizona, November 17th 2010. (Sierra Vista is the only hospital in this rural Arizona three-county area situated near the Mexican-US border.)

[15] “Maternal Deaths in the United States: A Problem Solved or a Problem Ignored?”, Ina May Gaskin, CPM, MA, The Journal of Perinatal Education, v. 17(2); Spring 2008

[16] Isabelle L. Horon, Dr. PH, “Underreporting of Maternal Deaths on Death Certificates and the Magnitude od the Problem of maternal Mortality”, American Journal of Public Health, March 2005; v.95(3):478-482.

The middle class “feminists” who claim to be allies of their poorest and most downtrodden “sisters” haven’t a clue what a poor woman’s daily struggle in deep poverty is like.

Even the most generous, non-materialistic middle class “allies” of America’s poorest women refused to comprehend or accept the poor welfare mother’s preoccupation with their very urgent and pressing need for money.

Most of these so-called allies, who have never lived the savage realities of destitution and being among the ranks of America’s economically disappeared, viewed poor women’s concerns about money as an “entitlement mentality.”

Petty bourgeois feminists referred to poor single mothers as “con artists” who wanted to get money for “doing nothing”, accusing poor women of “only getting pregnant for the welfare check” — buying into the sexist, patriarchal capitalist idea that pregnancy and childbirth is “nothing” for women to go through even though pregnancy and childbirth complications still kill more women in the US than in many other countries, and that the unpaid work that women have always traditionally done is “nothing”; that home-making, care-taking or child-raising isn’t “work.”

What care-takers do IS work — just ask anyone who has ever had to choose between their McJob or their sick child, or forego a job search in order to take care of an aging parent or a terminally ill spouse (or domestic partner). And mothers need a hell of a lot more than a cheap box of chocolates and a ten cent Mothers’ Day card. Poor women need money.

Yet, because of being sold out or abandoned altogether by Eurocentric middle class feminists, America’s poorest of the poor — women on welfare (before Welfare Reform eliminated AFDC and reduced benefits) — found themselves in situations where those who didn’t have to live with the consequences of “pragmatism” and political “compromise” were the ones defining the situation.

There’s a huge difference between the slightly better off working class guy in temporary poverty who just needs a job and a chronically poor woman who has been out of the job market for many years, serving as a care-giver or as a sole parent. Care-givers and mothers really need, and deserve, an adequate income.

Yet, as the Reagan Revolution’s War on the Poor right along up to Clinton’s Welfare Reform Act, which was driven by most middle class “feminists”, each subsequent part of “welfare reform” grew more punitive as America’s poorest women were told by suburban-dwelling soccer mom feminists who claimed to be allies, that poor women on welfare had to be “pragmatic” because “compromise” via benefit reductions and 2-5 year time limits coupled with “work requirements” were necessary. But all of those pragmatic “compromises” were no compromise at all because America’s poorest women got nothing but subjected to economic terrorism with a proverbial gun pointed right at our heads. We gained nothing at all, and lost all the way around.

The final slap in the face was that there wasn’t even a guaranteed right to a living wage job as part of this “welfare reform.” No one knows exactly how many poor, hard-to-employ women remained jobless and were plunged into homelessness and utter destitution after being thrown off of welfare at the end of their 5 year lifetime benefit limit. Homeless people have been criminalized and driven underground, including children, who were also denied a basic public education for lack of an address.

Middle class “feminists” ignored that issue, after talking down to their poorer “sisters”, lecturing us on the need to be “pragmatic.” Well, with poor people’s life expectancy rates, preventable blindness and other disability rates, infant death rates, and maternal mortality rates that have now surpassed those in several other Third World countries; we see exactly what middle class pragmatism gets us.

This is what happens when middle class “allies” and activists lead and run social justice movements, presuming the right to “speak for” the poor. They think they’re the only ones qualified for the job to act as brokers and middle-men for the poor, and that their class status gives them that qualification. Others end up having to suffer the losses they personally won’t ever have to live with (or die from). And they expect poorer people to do all of the really hard, thankless and unpaid work while they get to speak at all the events, collect all the honorariums, get all the media attention and press coverage, and take all the credit for brokering the deal.

But they don’t want to do all of the unglamorous, energy-sapping and time consuming and grinding work of survey-taking and petition-signing, and doing what it takes to get 200 people to a rally. And that does take a lot of work. All those people don’t just show up simply because they saw someone’s name on a flyer!

While the bourgeois feminists’ movement was preoccupied with battling lifestyle-related issues, poor women have been fighting in the trenches for our rights to equal access to societal resources and benefits — including equal rights to the living wage jobs and equal pay. We didn’t care if we could burn our bras or publicly make out with a partner of the same sex. We care about being able to survive. We’re struggling for equal access to adequate employment, educations, and for the legitimization of income support as compensation and recognition for care-givers and mothers.

The class restrictions that kept white middle class women in the kitchen wasn’t our reality; poverty, racism, and sexism was. Although NOW made an official statement saying it was committed to protecting the now-extinct miserly and inadequate safety net of AFDC, including abortion and dental care covered by Medicaid for poor women, the majority of NOW ‘s petty bourgeoisie membership didn’t follow through. The rights of gays and lesbians to marry (albeit an important right) was far more important than poor women’s fundamental human right to life, to adequate food, utilities, shelter, a job and/or income support, and to birth control and abortion access and the right to medical and dental care — all of which are life and death matters for poor women.

In wandering into the morass of the trivial issues of bra-burning and trashing Playboy, petty bourgeoisie feminists completely betrayed the struggle for women’s most fundamental human rights and that has had a devastating impact on the lives of poor women without jobs or any means of income support.

Women suffering the real oppression of daily economic terrorism that poverty is, including the repercussions of forced pregnancy and forced childbirth-promoting laws that led to the criminalization of miscarriages and stillbirths, and the conscription of poor women into reproductive chattel slavery at peril to our health, wellbeing and lives — all of this has been ignored by middle and upper class feminists.

What they won’t ever admit is that they have benefited from the ongoing oppression and exploitation of their much poorer “sisters.” They never intended for poor women to benefit from all that equality they were seeking for themselves.

They’ve been silent for over 30 years since the passage of the Hyde Amendment in 1976 followed by the Rapists’ Rights Lobby’s “conscience clause” and “fetal personhood” laws that have cropped up over the last 20 years, and the decimation of the meager and inadequate safety net that welfare was prior to 1996 when Slick Willy eliminated welfare as we know it, plunging 14 million poor single mothers into instant destitution and homelessness under the guise of “tough love.”

There is no comparison between the “quiet desperation” of affluent women like the late Princess Diana of Wales who got tricked into miserable marriages with over-privileged inbred crowned heads or members of the financial aristocracy merely to serve as an incubator for the economic cannibal class’s parasitic progeny after buying into the Cinderella-Prince Charming myth and wanting all that royalty has to offer, versus the very real crushing and life-endangering exploitation and abuse suffered by poor women and girls from the underclass — like 15 year-old Rennie Gibbs, who began her life imprisonment sentence this 4th of July (ironically, on the day American’s celebrate “Independence”) by a Mississippi court for the “crime” of delivering a premature stillborn, thanks to all of the “pro-life” laws and a Christian Right state in which there is no Planned Parenthood or any abortion clinic.

We still do not know anything about the male co-conceiver, such as whether he drank or did drugs which resulted in defective sperm which could have precipitated a miscarriage or stillbirth. We don’t even know if the sex (or the resultant pregnancy) was consensual.

But nobody cares about the plight of poor women, especially those of us who have been marginalized and excluded from the workforce for two or more generations — due in no small measure to the stigma of poverty and all the other barriers of classism that go with that which serve as obstacles to beat poor women down over and over and over, as vacuous middle class spoiled brats who are lucky enough to have good jobs tell us that no matter what we’ve tried to do to be “deserving” of a chance, we’re not doing anything right, not trying hard enough, not responsible, or just plain not good enough.

Dealing with issues of race and gender doesn’t meant you’ve dealt with classism and unearned privilege. There’s a world of difference between the working poor who struggle to get by from paycheck to paycheck who are one car breakdown away from losing everything and the very poor who’ve been trapped by generational poverty and all of the stigma and obstacles to getting a job (when there’s never been enough jobs for everyone anyway) that chronic poverty imposes.

The long-term poor who have been excluded and marginalized suffer the worst; neglected and abandoned on the outer fringes of society, struggling in destitution outside of the “primary labor market” of steady jobs. Those who are lucky enough to have enjoyed steady employment think that those of us with nothing in chronic poverty lack work ethic and discipline.

But it takes a hell of a lot more work ethic and discipline to survive even just one day in our lives, than it does to simply show up and perform some tasks assigned by some boss at an office.

Try scrounging money for food or a utility bill by salvaging scrap metal off the street in all kinds of weather, stripping wire until your hands are bleeding and calloused, and getting all cut up from handling scrap metal for 80 hrs/week just to get maybe only $100 (or whatever meager price the salvage yards feel like paying out based on prices that they set, depending on what the metals commodity brokers dictate). Then come and talk to me about “being responsible” and your “work ethic.”

Try having to live like that, hoping to get enough money to put towards a cheap prepaid cell phone just so you have a means of communication for things like being able to call the police or fire department in an emergency, or being able to keep trying to get a job while suffering from dental problems that you can’t get treated because you have no money and no job with dental benefits — never mind maybe eventually being able to repay that unaffordable student loan debt you incurred in hopes of being “worthy” of a chance for a job so you could climb out of poverty before getting “too old” for anyone to hire.

And of course, those of us in poverty who tried to do “all the right things” get nothing but slapped in the face by middle class snobs who always tell us how “irresponsible” we are if we have no income and have no way to document the fact that we have no income to the satisfaction of some snippy rude middle class bureaucrat at the student loan servicing center, and therefore we’re told we can’t qualify for any deferment or income-contingent repayment plan.

Middle class snobbishness and pragmatism blinds society’s more fortunate and luckily employed from that savage reality of poverty and classism. For those of us who have never had a moment’s comfort and security throughout our entire lives, pragmatism is merely a license for maintaining a status quo in which nothing ever gets better for us and there is no hope that anything will ever change.

Middle class (and often working class) pragmatism really amounts to “how can I get a better deal for ME” by using those of us at the very bottom as their poster child to further their own agenda while never sticking by the poor to help us get a better deal, too. Instead, we get jettisoned the minute they get a few token bones tossed their way. And what do chronically poor women get? Nothing. Or worse.

We get our food stamps and Medicaid cut, our LIHEAP funding cut while utilities skyrocket and things like heat in the winter or a hot shower are unattainable luxuries. Now we got our social security cut, and we lost our access to reliable birth control through Planned Parenthood as defunding Title X caused them to close their doors in several states already.

Chronically poor and jobless women like those of us from generational poverty were never included or accepted in the job market even during the “better times” — and we’re supposed to grateful to our middle class “benefactors” for their “wins” of pragmatism that always benefit everybody else except us? For us, these are life and death realities; not a tally of “wins” in the game of political football.

Until middle class feminists and the steadily employed working class “social justice activists” realize this and deal with their classism, they will continue to alienate the very poor and lose what little bit of trust we may have had in them in the first place. They have yet to do right by their poorest and most marginalized “sisters.” I won’t hold my breath in hopes that they ever will.

Because poor people never win in coalitions. Cross-class coalitions mean using the chronically jobless poor for the ends of middle class people. Those of us from generational poverty were never meant to be included. So what’s the point in voting when we’re always neglected or offered up as the convenient sacrificial lambs at first chance?

While women lucky enough to have a job, even if only a crappy one, can now get their birth control through Obamacare without co-pays, chronically poor women without jobs (or any chance of ever being able to get one) have lost everything with cuts in Medicaid and Planned Parenthood closings, leaving us with nothing — not even basic maternity and post-partum care to at least reduce the already higher chances of death and disability for us as a result of having no options other than carrying unwanted pregnancies to term. And for this, we’re supposed to be grateful to our middle class “saviors?” When we get a share of the pie for once and get access to real choices and options, then we’ll do the victory dance, too.